vitalityvet2019@gmail.com
306-782-VETS (8387)

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New clinic location coming Spring 2025

New Client Intake Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

New Client Intake Form

Date *

Owner Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone Number: *

Email Address *

Emergency Contact (Full Name)

Emergency Contact Phone Number

How did you hear about us? *

Other *

Pet's Name *

Species *

Breed *

Sex *

Spayed/ Neutered *

Age *

Color *

Tattoo / Microchip

Known Allergies (please list) *

Please list any medical conditions our team should be aware of: *

Please list any medications or supplements your pet is currently on: *

Would you like your records transferred from another veterinarian? *

Yes
No

Clinic Name *

for official pet(s)

Phone Number *

Do you have any other pets in your household? *

Dogs
Cats
No other pets

Do you have pet insurance? *

Yes
No

I give permission to Vitality Veterinary Services to post pictures/videos of my pet(s) on the hospital's official social media or website accounts. *

Yes
No

I hereby authorize Vitality Veterinary Services to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid at the time of release and that a deposit may be required for surgical treatment or hospital treatment. *

I have read and agree

Signature *

Clear Signature

Schedule an Appointment Today!

We proudly serve the large and small animals of Yorkton, Canora, Kamsack, Norquay, Pelly, Preeceville, Invermay, Theodore, Foam Lake, and Melville. Please click the button below to book an appointment.

Book Appointment

Have a Question?

Please complete our online form and a member of our team will get back to you as quickly as possible.

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Location

38 Smith St. W.
Yorkton, SK, Canada
S3N 3X5

If your question or request is urgent, please call the clinic directly.

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Contact Details

Phone: 306-782-VETS (8387)
Email: vitalityvet2019@gmail.com



Hours

Mon – Fri : 9:00 am – 5:00 pm
Sat – Sun : Closed

After-hour emergency services provided 24/7.

Name *

First

Last

Email *

Phone

Name you? we

How can we help you? *

Email

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